Medical case narrative
A 17-year-old whose only symptom was psychosis — and whose calcium was 16.5
What happened
A 17-year-old boy, a 12th-grader, was admitted to an inpatient psychiatric unit with acute psychosis: two to three weeks of aggressive, hostile, angry moods with paranoia, auditory and visual hallucinations, delusional ideas, sleepless nights spent pacing his bedroom, and suicidal and homicidal thoughts. He had jumped out of a moving car and fractured his right arm. His psychiatric label lasted about a week — the shortest in this batch alongside Entry 9 — because the psychiatric unit ran routine laboratory screening. This is the "screening worked" entry of the batch, printed as such rather than stretched into a long-mislabel story.
What it looked like
Frank psychosis, and notably nothing else: he denied bone pain, abdominal pain, and kidney stones, and no excessive thirst or urination story was recorded. Psychosis was his only presenting symptom. (Two parts of his background are printed because the report prints them: behavioural problems and a learning disability dated from second grade, years before any adenoma could explain them — and he remained under psychiatric care for behavioural issues for about six months after his calcium normalised. He also smoked marijuana two to three times a week, a confounder the report records.)
What the labs found
The routine screen: serum calcium 16.5 mg/dL (normal range 8.9–10.7) with intact parathyroid hormone of 315 pg/mL at first detection. His numbers shifted across the admission and are printed with their time points, as both reviewers required: the receiving hospital's retest gave iPTH 242 pg/mL, and the report's pre-treatment table gives total calcium 18.0 mg/dL and iPTH 350 pg/mL. A sestamibi scan lit up just below the left lobe of his thyroid; genetic testing for the inherited MEN syndromes was negative. At surgery the gland weighed 1.3 g and proved to be a benign overgrown parathyroid gland — primary hyperparathyroidism: one small gland flooding his blood with calcium, and his brain was where it showed.
What changed
Fluids and calcitonin lowered the calcium only moderately and unsustainedly. The gland was removed on hospital day 5, about a month after the psychosis began; his calcium normalised within 48 hours. His paranoid and violent behaviour then resolved gradually over about two to three months — not overnight, and not completely into a cure narrative: the behavioural care continued for months after, as noted above.
The test that told the story
Serum calcium (with intact PTH) — on the psychiatric unit's routine admission labs. The basics, run by default, caught in a week what symptom-watching alone would have missed.
Sources: Babar & Alemzadeh 2014 (primary case report, all values and time points); Corredor-Orlandelli et al. 2023 (independent case report whose literature table re-extracts this patient: 17/M, Ca 16.5 mg/dL, iPTH 242 pg/mL); Frontiers in Surgery 2022 (further summary of the same case).